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Wither Medicine – 2022

medicine Phot credit: Chai PR et. al, JAMA Open Network Article

Many of us speculate about how changing technology is going to impact on Health Care over the next century. One thing is clear, the Corona Pandemic will accelerate change.

The most striking change will be the increasing incorporation of remote access or "Telemedicine" into usual methods of care. Traditionally, there always has been an option of calling one's physician seeking advice by telephone. A more recent innovation, preceding Corona, was the use of nurse practitioners to provide advice and guidance. Presently, there are active efforts in the Kupot to develop and provide algorithm-based remote advice.

With the advent of Corona in March 2020, I resigned after 9 years from the Clalit Research Institute but I maintain an active interest in "Wither Medicine".

As a case in point, I present here on a recently published study reported on the JAMA (Journal of American Medical Association) Network.

Meet Dr. Spot, a four-legged robot developed by Boston Dynamics in the U.S. Dr Spot was assigned to do triage in the Emergency Department of Brigham and Women's Hospitals in Boston during the peak of the Corona wave so as to preclude physical and face-to-face contact between the patient and the health care provider. Tasks assigned to the robot included; drawing blood, inserting an IV-line, obtaining nasal and oral swabs, measuring vital signs, positioning and turning patients in bed, and facilitating remote interviews between patients and physicians or nurses.

Imagine if you will, coming into a crowded Emergency Department and, rather than being ignored, being approached by Dr. Spot. He/she will ask about your presenting symptoms, take your temperature, pulse and blood pressure, draw your blood and possibly, if appropriately programmed, hold your hand and wipe your sweaty brow.

The objective of the study was to assess the acceptability to the patient of robot-based care. The overwhelming majority of the patients (85%), given the exigencies of Corona, found the robot facilitated care to be satisfactory.

Another case in point regarding "Wither Medicine" is described in a recent article in the New England Journal of Medicine titled "In Clinical Care, What Will Amazon Deliver?" In the article they emphasize that Jeff Bezos, the Founder and CEO of Amazon, realized the great potential for industrialization in the health care industry and has had a top-secret working group developing plans for many years.

Amazon Care is described in the NEJM article as follows:

"Amazon Care, the company's virtual-first clinical care offering, is one outcome of this work. The service is a combination of telemedicine and in-home care, comprising three components: a smartphone-based app that uses a chatbot and then allows text or video interaction with a nurse and, if desired, a doctor; homebased diagnostic assessment, if necessary, performed by a nurse; and delivery of prescriptions within 2 hours if patients choose to use Amazon's pharmacy, which came online in November 2020. Amazon Care is a "hybrid virtual and in-person experience" in which providers who "might need a little bit more information can dispatch a nurse to the home, and if necessary, the nurse can call back in order to make the diagnosis," Sunita Mishra, medical director of Amazon Care, explains.

Kristen Helton, director of Amazon Care, notes that employing a nurse, rather than a doctor, for the in-home component was a cost-effective choice but also "a data driven approach" — the company considered all visit types and calculated that it "could cover a significant percentage of care with a virtual provider coupled with an in-person nurse."

Amazon Care is presently operative in several U.S. cities. It competes with commercial consumer-based health care services such as those provided by growing numbers of Pharmacy Groups. At present more extensive application of the model is limited to acute urgent care as there is no Health Insurance Reimbursement for such virtual services but I mention it here as an indicator of how virtual tools will be introduced into clinical practice.

Lastly, we have to discuss the place of Artificial Intelligence (AI) in the Medicine of the future. The advent and widespread use of electronic medical record keeping has made trillions of items of data available. Modern super computers can process data with amazing speeds and accuracy. In its simplest iteration, AI attempts to detect relationships that exist within that data mass to try to deliver more precise personalized medicine to the patient. The computer, rather than depending on population based clinical studies, will find patients with symptoms and genetic make up similar to the patient's and based on that select the most appropriate treatment protocol.

An exciting aspect of AI in Medicine is that, other than Kaiser-Permanent in the U.S., the Israeli Health Care Funds have the largest existing medical databases in the world. Both Clalit Health and Maccabi Healthcare Funds are actively engaged with both Academic Institutions and Industry to harness AI for more effective health care services. One example of such collaborations exists in the Maccabi application as K Health. The following are Blurbs taken from the K Health and Maccabitech websites and provides their descriptions of their joint products.

Illustration: Liora Blum

K Health

K Health offers free, personalized and user-friendly health guidance. With just a few clicks, you'll be able to learn how people like you were diagnosed and treated by real physicians.

The K application was developed by K Health using the unique physician-based dataset from KSM & Maccabi. By mining the anonymized free-text dataset with millions of doctor notes from patient-doctor visits in Maccabi, K was able to create sophisticated machine learning models that find people who are similar to each and every user. K continues to learn from ongoing interactions between users and Maccabi physicians - making sure every user gets the best possible medical information.

Maccabitech

Embedded in Maccabi Healthcare Services, one of the world's largest non-governmental non-profit health providers, is research heavily based on rich electronic data that spans over 30 years and over 4 million medical records. Using high-quality data and cutting edge analytics, Maccabitech is devoted to expanding knowledge and to enhancing the quality of care to our members.

I assessed the Maccabi application by a simulated clinical profile. It is slow and not terribly user-friendly. The advice I received at the end was appropriate. It is, however, amazing that such an application exists, that it is in an ongoing process of development and assessment, that it is being developed here in Israel and that it will be, in my estimation, "a light unto the nations" as to how one can harness AI for mankind's benefit. 

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Tuesday, 09 August 2022

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